Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre observational study (CarDINe Study).

Humans Fluorodeoxyglucose F18 Positron Emission Tomography Computed Tomography / adverse effects Defibrillators, Implantable / adverse effects Retrospective Studies Radiopharmaceuticals Risk Factors Cardiovascular Infections Gram-Negative Bacterial Infections / epidemiology Obesity Prosthesis-Related Infections / epidemiology

CIED infection Cardiovascular implantable electronic devices Endocarditis FDG PET/CT Gram-negative

Journal

International journal of antimicrobial agents

ISSN: 1872-7913

Titre abrégé: Int J Antimicrob Agents

Pays: Netherlands

ID NLM: 9111860

Informations de publication

Date de publication:
Mar 2023

Historique:

received: 07 11 2022

revised: 11 01 2023

accepted: 13 01 2023

pubmed: 24 1 2023

medline: 21 3 2023

entrez: 23 1 2023

Statut: ppublish

Résumé

Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067). Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected.

RESULTS RESULTS

A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067).

CONCLUSIONS CONCLUSIONS

Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.

Identifiants

DOI: 10.1016/j.ijantimicag.2023.106734 PMID: 36690123

pubmed: 36690123

pii: S0924-8579(23)00022-5

doi: 10.1016/j.ijantimicag.2023.106734

pii:

doi:

Substances chimiques

Fluorodeoxyglucose F18 0Z5B2CJX4D

Radiopharmaceuticals 0

Types de publication

Observational Study Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

106734

Investigateurs

Natascia Caroccia (N)

Francesca Fanì (F)

Federica Arbizzani (F)

Ramsiya Ramanathan (R)

Paolo Scarpellini (P)

Alessandra Marzi (A)

Patrizio Mazzone (P)

Filippo Placentino (F)

Giulia Sammarini (G)

Elena Tenti (E)

George Leventopulos (G)

Giulia Domenichini (G)

Meyha Şahin (M)

Milagros Suárez-Varela (M)

Elkin González Villegas (EG)

Informations de copyright

Déclaration de conflit d'intérêts

Competing Interests All the authors report no conflicts of interest.